AUA Convention Chicago - 2003

Two centuries ago, Chicago - originally Checaugou, named by the Potawatomi indians after wild onions that grew here - was still a swampy settlement at the shores of Lake Michigan - originally probably also called diferently by the indians. In 1863, the town was connected to the Mississippi by a canal, which started a still going growth. The direction of the Chicago river, which was deadended, was turned 180 degrees towards Lake Michigan; not illogical for evident sanitary reasons. One of the famous tall buildings is Sears Tower, recently rechristened SARS Tower for unknown reasons. The vast number of inhabitants of the town - 3 million in Chicago proper and 8 million in its surroundings - rather downsize the large number of museums.
The AUA welcoming reception was tightly organised, but yet your reporter team was able to attend it at the museum of Science & Industry, featuring trains, planes and automobiles. One of its highlights is the U505, a german WWII submarine, captured by the American Navy in 1944, that has been recently restored to its former 'glory' and can be visited. These submarines were even more cramped than an OR.

News from the AUA frontline:
The convention is now in full swing: a lot of sessions, a lot of abstracts. Fairly few of the poster racks remain empty, mainly because some (FarEastern) delegates choose not to come, either because of the Iraq war or because of SARS.

Early morning is indeed early, but the three-day-year-old jetlag helps to overcome that problem, so even an an explicitly late-nighter like me does not have a problem (yet).
Is a continent deviation superior to an ileal conduit? The Point-Counterpoint discussion between Donald Skinner and Udo Jonas did create argumental problems for ileal conduit afficionado Jonas. Fortunately for him, the applause measurements did not funtion correctly. Jonas emphasized the simpleness of the procedure, which has clear advantages when adjuvant chemotherapy or radiotherapy is planned. Skinner ventilated the opinion that all patients should be offered the option of a continent deviation unless there is a renal problem, a short bowel or insufficient motivation for intermittent catheterisation. So: 'Any urologists should have specific reasons for not offering it'.

Also present in the plenary sessions: Stephen Kaplan presenting the surrent state of affairs on medical treatment of BPH. Lots of Powerpoint slides in high gear. At the end again the MTOPS trial, presented last year but evaluated further comprising some 3000 patients. He concluded that combination therapy (alpha-blocker plus 5alpha-reductase inhibitor) gets the best results.

Uro-oncology:
The Swedes presented the results of an important randomized study (abs 689, Sweden): radical prostatectomy vs. watchful waiting. After 8 years, the cancer specific mortality differs 8 percent, but without an overall statistically significant difference: only one in 17 radical prostatectomy patients. Apparently very small differences. Losts of criticism and compliments from the audience.

or 8 months Some conclusions from another important study: neoadjuvant hormonal treatment for 3 or 8 months predating radical prostatectomy does not show any differences in recurrence of tumor and other endpoints after a rather minimal follow-up of three years (abs 690, USA). The question remains whether treatment results of radical prostatectomy through neoadjuvant hormonal therapy will ever be better.

Strontium treatment for bone metastasis scores better concerning Skeletal Related Events than bisfosfonates (abs 942, Nteherlands). The results seem also due to an inequal distribution of patient characteristics between the patient groups despite adequate randomisation. It is concluded that APD and Strontium are probably as effective in treating bone metastasis of prostate cancer and lead to a significant 60-75% less pain and use of painkillers.
In hormone refractory prostate cancer, a vitamin D independant calcium resorption problem seems to play a role. Suppletion of calcium is advised for this patient category (abs 939, Netherlands). This has to be given together with vitamin D to allow for extra uptake of the calcium.

Female urology:
Elective cesarean section seems to be able to 'prevent' stress incontinence 1 year after delivery. Only 4 of 118 patients will become stress incontinent, identical to women who never had any children (abs 1047, Israel). centage of stress incontinence is 10-12 percent. The question whether we should now advise all women to have a cesarean was not answered.

Young Caucasians have a tenfold chance to develop urothelial cancer after the diagnosis of prostate cancer (abs 865, USA), while colon cancer leads to a four fold increase. Although the toal incidence is still pretty low at that age, these facts should be taken into account in daily practice.
A lot of new websites have seen the light - many will probably also have a short half-life. Even the AUA has started a patient information website, www.urologyhealth.org. They finally follow our example...
The number of journalists attending the AUA is still increasing until about 160 this year. Tom Grady, for years the 'king' of the pressroom is in his last year now. Even Bill Glitz, his predecessor, came around to visit his old office and to drop off press information for a pharmaceutical company he is now working for (Mission, what's in a name). Despite the changes over the years, the pressroom seems to get better each year. So much for the press.

Getting around remains pretty cool, in a negative sense, due to the Deluxe airco installed in the building.
Having said that,

More tomorrow.

ENGLISH version 26 April 2003 27 April 2003 28 April 2003 29 April 2003 30 April 2003

DUTCH version 26 April 2003 27 April 2003 28 April 2003 29 April 2003 30 April 2003